摘要：Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies’ influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. “Fast-track authority,” in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests. The 2011 United Nations high-level summit on noncommunicable diseases (NCDs) identified NCDs as the health issue of the 21st century. 1 Unlike infectious diseases, many NCDs result from exposure to or consumption of unhealthy products, including tobacco, which is promoted by transnational corporations. 2,3 The tobacco companies’ ability to dominate the public policymaking process is the main reason the global tobacco epidemic has persisted. 4 This situation is changing because of increasingly effective political mobilization by health interests at all levels, from enacting local laws mandating smoke-free workplaces to implementing the international World Health Organization Framework Convention on Tobacco Control (FCTC). 5 The FCTC has accelerated the diffusion of strong health warning labels on tobacco packages 6 and promoted other policies to reduce tobacco use, including smoke-free environments and high taxes on tobacco products. 7 Although implementing these policies is good for health, the associated reductions in tobacco consumption are costing the tobacco companies billions of dollars in lost sales, 8 which motivates them to redouble their efforts to block these policies. One of the tobacco companies’ key strategies to block or reverse tobacco control policies is preemption, in which they secure legislation by removing authority from subordinate jurisdictions where tobacco companies are weak and transfer it to jurisdictions where they are strong. 9 For example, in response to efforts by US states to require strong warning labels on cigarette packages and advertising in the late 1950s, tobacco companies agreed in 1966 to have Congress require weak warning labels on the sides of cigarette packages in exchange for preempting the states from doing more. 10 Likewise, in the 1980s, as localities started passing smoking restrictions, tobacco companies won state preemption in 26 states, 11 effectively stopping policy innovation in those states until 1999, when preemption started being repealed. 12 (Tobacco companies have also used preemption to fight smoking restrictions in Mexico 13 and Argentina. 14 ) Although tobacco companies pioneered preemption as a strategy, other industries have begun to use it. 15,16 In 2011, the Institute of Medicine highlighted the importance of avoiding preemption, recommending that federal and state policymakers “should set minimum standards . . . allowing states and localities to further protect the health and safety of their inhabitants,” and “avoid language that hinders public health action.” 17 (p3) International trade agreements, negotiated with little public oversight, provide corporations, including tobacco companies, a powerful opportunity to impose de facto preemption on national and subnational jurisdictions to implement health regulations.
